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Paediatric Rheumatology

 

Methotrexate treatment may prevent uveitis onset in patients with juvenile idiopathic arthritis: experiences and subgroup analysis in a cohort with frequent methotrexate use

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13

 

  1. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia. mikhail.kostik@gmail.com
  2. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  3. Eye Care Physicians and Surgeons, Winchester, VA, USA.
  4. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  5. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  6. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  7. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  8. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  9. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  10. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  11. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.
  12. Università degli Studi di Genova; and Istituto Giannina Gaslini, Genova, Italy.
  13. Saint Petersburg State Paediatric Medical University, Saint-Petersburg, Russia.

CER9183
2016 Vol.34, N°4
PI 0714, PF 0718
Paediatric Rheumatology

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PMID: 27385618 [PubMed]

Received: 12/12/2015
Accepted : 26/02/2016
In Press: 22/06/2016
Published: 14/07/2016

Abstract

OBJECTIVES:
To re-evaluate the ability of methotrexate (MTX) to prevent the onset of uveitis in Russian children with juvenile idiopathic arthritis (JIA).
METHODS:
The clinical charts for all consecutive patients who received a stable management for at least 2 years with or without MTX were reviewed. Patients who were given systemic medications other than MTX (except NSAID) and patients with systemic arthritis, rheumatoid factor-positive arthritis, or enthesitis-related arthritis were excluded. Each patient was examined after at least a 2-year follow-up period after the first visit to establish whether uveitis had occurred.
RESULTS:
A total of 281 patients with a median disease duration of 3.8 years were included. 191 patients (68%) were treated with MTX. During the observation period, 64 patients (22.8%) developed uveitis, a median of 1.6 year after disease onset. The frequency of uveitis was lower in MTX-treated than in MTX-untreated patients (11.5% vs. 46.7%, respectively, OR=6.7 (95%CI:3.7–12.3), p=0.0000001). Survival analysis confirmed that patients treated with MTX had a lower probability of developing uveitis (HR=4.35, p=0.000001). In subgroup analysis it was shown that MTX was more preventive in boys than in girls, and in patients with JIA onset age of over 5 years compared to those with disease onset less than 5 years. The data of survival analysis of MTX prevention has shown that benefits do not depend on the number of active joints and ANA status.
CONCLUSIONS:
MTX therapy may prevent the onset of uveitis in children with JIA. Further randomised controlled trials are required to confirm our results.

Rheumatology Article